Postnatal Care For Mommies


Care For Mommy ~ Doula Agreement

Our goal is to mother the mother during the fourth trimester



Family Name: ___________________________________             Due Date: _____________


Time of Birth

As your postpartum doula, we will make arrangements in advance of your first day home with your baby. Most families do not need their postpartum doula the first day they arrive home. However, if you feel my presence would be helpful, please let me know as soon as possible so that I may arrange to be available for you and your family.


Role of the Postpartum Doula

The major role of the postpartum doula is to help the family make a smooth adjustment during the first several weeks after birth and to help educate them in the normal course of care for both mother and baby.  Postpartum doulas are educated in the normal course of the postpartum period and can help advise you when you should seek advice from your provider or your baby’s doctor.  However, postpartum doulas do not perform medical tasks, assessments, give medical advice, give medications or perform clinical services to either the newborn or mother. The services I provide include but are not limited to: light grocery shopping of necessities,  running errands, assisting infant and sibling care while mother rests; educating the new family in baby care and feeding methods by following the pediatricians guidelines or that of the American Academy of Pediatrics; light housekeeping; answering the telephone and greeting guests; light meal preparation; laundry and loading/unloading the dishwasher as well as accompanying mother and/or baby to follow-up appointments. Studies have shown that women who have social support during the postpartum period tend to have less postpartum mood disorders, breastfeed for a longer duration, and make a better adjustment to parenthood. 


Please note: Due to insurance regulations I am prohibited from transporting mother or baby or any siblings in my car.  Schedule appointments when a family member or friend is available to transport you. 


Limits of Practice

Postpartum doulas do not provide medical care or administer any type of prescription or over the counter medication to you or your baby. However, I am well versed in the normal postpartum recovery period and infant care not only as a doula, but also as a mother.  Should I feel the course of recovery is not going as planned I will advise you to contact either your physician/midwife, or the baby’s doctor. I can also refer you to resources such as LaLeche League as well as the names of IBCLC’s – lactation consultants that make home visits, or someone who assists with sleep training for your infant. As a postpartum doula I do not scrub bathrooms such as tubs or shower stalls, vacuum the whole house in one day, move furniture, clean refrigerators, ovens, or scrub floors on hands and knees.  I will wipe appliances after use and clean the microwave on a regular basis as part of light housekeeping chores.   I do not clean windows or do any chore involving climbing on a ladder.  I do keep the house straightened and organized and clean up after preparing a meal.  I can help you find a housekeeping service if you do not already have one and feel that would be valuable during this time.


I also do not baby sit or stay alone with, or discipline infants or toddlers. I will take care of the baby while mother naps, showers or takes a short walk in the neighborhood for fresh air. If you require the services of a nanny or babysitter, I can help you in figuring out your needs and how to retain that kind of assistance. transport any member of the family.


I reserve the right to refuse to perform any duties that I feel are out of my scope of practice or which may endanger my or anyone else’s physical well-being. 


Bad Weather

During times of bad weather, I will use my judgment to decide if I can safely travel that day. During ice and snow storms I will not risk myself or others and may choose to make the decision to attend to you and your family on another day. I will always call and discuss this with you.



Illness (non-COVID-related)

If anyone in my household is ill with more than just a minor cold, I will notify you and you will have the option of having me come on that day or rescheduling me for another day that week.  Typically, minor illnesses do not transfer from a third party and good handwashing will suffice.  I would also like to know if anyone in your household is ill, since my getting ill could impact other client families as well as my own.


Breaks and Rest Periods

I will be taking small breaks and rest periods throughout the time I am with you should my visit last 4 or more per hour per day. Typically, I eat meals with families. We can use this time to answer questions, address concerns, or simply talk over anything on your mind. During this time, I am still on the clock. I will try to limit this time, but I do need small breaks for meals and to refresh so that I can give you my best.  Usually I bring my own food unless advised otherwise.


Away time

On days when we are not together, I am either recharging, or with family and or friends. It is greatly appreciated that if you have questions, and it is not an emergency in nature that you text me should you need me to call you back.  If it truly is an emergency and concerning the health of you or your baby, then you should call your provider or 911 for medical advice.  I recommend that you set up a communication notebook for you to write down your questions to be asked at my next visit.


Visits and Fees

I am available for hire at a minimum of 4 hours a day, once a week. Beyond that, between to 4-8 hours a day up to 4 times a week. I am open to providing 5 half-days of service, during the first two weeks. 


Typically, a postpartum doula is with a family until about 4-6 weeks after birth. Please indicate approximately how long you would like to contract for my services.  This helps me better plan to work with other families and my overall schedule.  If at the end of our agreement you are still interested in keeping me on, I am happy to extend this agreement under the same terms if I have not already committed to another family.


We cannot predict when birth will happen. Since I am only one person, if you birth earlier than expected and I am working with another family, I will try my best to find a replacement until I am available. However, this cannot be guaranteed.


  • Home visits during the day are set at 4, 6 and 8 hours, at a rate of $_______ per hr. Overnight visits are set at 8 hrs. at a rate of $_______ per hr.
  • Fees for visits which extend past 15 minutes into the next increment should be compensated at the next increment.
  • Weekends and hours after the first 8 hrs. on any given day are at a 25% premium over the standard daily or overnight rate.
  • Holidays (Easter, Thanksgiving, Christmas Eve/Day, New Year’s Eve /Day) are at a 50% premium.
  • When hired for less than 16 hours per week, if travel time exceeds 30 minutes, there will be an additional fee of $_______ per day.
  • If I run errands for you on my way to your home, the visit begins when I arrive at my first stop.
  • For errands and grocery shopping, please provide me with the necessary funds for items to be purchased before the errand.


Visits – Overnights

Overnight visits are unique and are limited in scope. Outside of the first and last hour of and overnight visit, services are limited to and focused on allowing parents to rest and allowing your baby to sleep. When your baby is sleeping, I will be resting. When your baby awakens, I will focus on their needs and work to get them back to sleep.


Visits – Schedules

If you decide to utilize my services for less than 8 hours a day you will need to decide if you want me for

the morning from 8-12 or in the afternoon from 1-5. This way I can work with two families on the same day and not limit my ability to provide my services.  For clients who agree to a set schedule, there may be a possibility to add an additional half or full day in any given week.


Visits – Cancellations

Cancellations are unavoidable at times. However, compensation is required for the minimum number of hours/days per week, as agreed to, up-front, per this agreement. When cancellations arise, I am willing to be flexible and work on a different day, in that same week, whenever possible.

When canceling with less than a 24-hour notice, I will charge my normal fee. This also includes when family unexpectedly stays over and they will be filling my role, as well as if you decide you no longer need my services before the conclusion of the week.


COVID Protocol

During the COVID-19 pandemic, I continue to personally social distance and remain safe for my family and yours. Should I experience any suspicious symptoms where I am unable to deliver virtual care, I will arrange to the best of my ability, a backup doula for your care until I have tested negative for COVID. In the case any member of your household experiences COVID symptoms, you must inform me immediately. At which time, we will switch to virtual postpartum care until the members of your household have tested negative for COVID. This protocol is to ensure everyone’s safety.

Virtual Care


Should Suffolk County return to full quarantine (meaning essential trips only), I will continue to provide care virtually to the best of my ability. This includes: video chat, phone, and text support



Weeks are Monday through Sunday. Payment should be made on the last scheduled day of each week of service. If for whatever reason that is not possible, then it must be made at the beginning of the first visit of the next week’s service. There will be a non-refundable retainer fee of $___________ paid when you select me as your doula. If all payments are current, the retainer will be applied to the last week’s fee.  Payments owed will be deducted. Amounts remaining will be refunded to you after two weeks.


Returned Payments

There is a $50.00 charge for returned checks plus any expenses, legal or otherwise incurred as a result of any form of non-payment. Please note there may be additional or updated terms on my website. These may be changed at any time and without notice.


Cancellation of Service

This is a contract for services over the time period noted under this agreement. Once you have signed, if you decide for any reason other than a hospitalization of the mom/baby that the signed upon services are no longer needed you are still responsible for the full dollar amount of this agreement. The retainer will not be refunded if you do not to call me once you give birth. Although it is rare, should an abusive situation arise, such as verbal or physical abuse by a client or family member, this will be reason for termination of this agreement without notice or refund, at which point the retainer will be forfeited, and any monies due for services through the end of the agreement term become immediately due to be paid.


Please make sure to complete a “home visit” before signing this agreement.    Completed on ____/____/____



_______hours per day                       _______ days per week                     __________# of weeks



Mo____ Tu____ Wed____ Thu____ Fri____Sa____Su____


(please indicate – Mornings, Afternoons or Overnights)


Payment of Services

  • Will be paying Cash ____________
  • Will be filing a 1099-MISC for contracted services ____________



                             _______________________________________________________              _______________________________________________________

Client Signature                                      Date                                                             Partner Signature                   Date